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Tag Archives: Care Management

Population Health Management (PHM)

Posted on September 1, 2016 | Categories: Population Health Management | Posted by: admin

Population Health Management (PHM)


  • Population health has been defined as “the health outcomes of a group of individuals, to reduce health inequities due to factors i.e. Financial, Social, Physical or Genetics”. It is not just the overall health of a population but also includes the distribution of health
  • Population Health Management (PHM) is a gradual and necessary shift from Volume to Value Care or in other words Population health Management (PHM) delivers value-based care viz. from earlier Fee for Service model to now Fee for Outcome
  • Accountability, Outcome and Meaningful USE (AOM) for population health is a key premise driving the value-based care movement
  • PHM – Value-based care (VBC) requires a proactive approach, where at-risk populations are identified, tracked and handled differently for desired Outcome than historically has been the norm
  • PHM-VBC promotes Care Coordination across different parts of the health care system with ongoing patient outreach and interaction to bend the cost curve while achieving comparable or improved patient outcomes
  • Population Health Management initiatives can reduce readmissions, improve community healthcare outcomes, and increase revenues
  • PHM can help avoid hospital admission of a heart failure patient who could be effectively treated in an ambulatory manner thus delivering better care and cost curve
  • Population Health is a great tool for population / patients suffering from 5 chronic diseases like 1. Cancer 2. CHF (Health – Cardio Vascular) 3. Diabetes 4. Mental Health & 5. Hypertension (BP)
  • Four Pillars of PHM are 1. Understand Population 2. Manage Risks 3. Coordinate Care 4. Improve Quality to address and reduce the Health Inequalities Gap (HIG) amongst Healthy and Not -Healthy Population


Achieving Population Health and Real Challenges


  • Analytics are critically important for helping Payers & Provider understand how best to target their limited resources in order to maximize patient care and financial outcomes. just knowing that a patient is likely to be a high utilizer of services or a high-cost patient is insufficient if HealthCare firm can’t actually impact the care or outcomes in an appropriate manner
  • Drive patient engagement by integrating telemedicine, patient portals, HIE/HIX and mobile devices in the care continuum
  • Establish realistic metrics to measure success
  • Extracting EMR-based Clinical Data (not Claims Data alone) is a must for population analysis, for the depth and understanding of populations and Population Grouping based on Risks & Ailments
  • Identifying patients that are candidates for extra management
  • Many healthcare care coordinators are still using paper-based, manual processes, as well as juggling tasks and patient caseloads on spreadsheets and homemade databases. That said, Under Delivery System Reform and Incentive Payment (DSRIP) funding from Federal (CMS/HHS) & State are available to Hospital & Health Systems to invest in the Population Health Technology for managing their Population & Communities’ health
  • Organizations are hamstrung by limited data sets and incorrect information, thus combining Payer-Provider and EMR-Claims Data is the right way to achieve true PHM-VBC
  • Resource, Workflow, Pharmacy and IT infrastructure investments are essential for clinically integrated network to improve population health
  • While electronic medical records (EMRs) have increased access to patient information, interoperability challenges remain in sharing data across multiple EMR platforms


Analytics for Population Health Management (PHM)


  • Ability to predict at-risk patients to reduce preventable costs
  • Accurate data powered by integrated clinical and claims data across the continuum of care
  • Ability to track and compare performance outcomes via deep comparative clinical benchmarks


Population Health & Care Management

Population Health is a tool to achieve Care Management. Both delivers same outcome. The Tools are:

  • Care Coordination
  • Case Management
  • Discharge Management
  • Disease Management
  • Medication Therapy Management (MTM)
  • Mobile Health or Wearable Health
  • Tele-Health


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ACOs of New York and New Jersey

Posted on January 4, 2015 | Categories: ACOs | Posted by: admin

ACOs of New York and New Jersey



An Accountable Care Organization (ACO), defined & approved by CMS, are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients. The goal of coordinated care is to ensure that patients—especially the chronically ill—get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.


Essentially all the IPAs and Hospital Groups are merging to become ACO’s. Key is Hospitals.


ACOs of New York


  • Accountable Care Coalition of Mount Kisco, LLC
  • Accountable Care Coalition of Syracuse, LLC
  • Accountable Care Coalition of the North Country, LLC
  • Asian American Accountable Care Organization
  • Beacon Health Partners, LLP
  • Bon Secours Good Helpcare, LLC
  • Chautauqua Region Associated Medical Partners, LLC
  • Chinese Community Accountable Care Organization
  • CIPA Western New York IPA
  • Crystal Run Healthcare ACO, LLC
  • Healthcare Provider ACO, Inc.
  • HHC ACO, Inc.
  • Independent Physicians ACO
  • Keystone ACO
  • Montefiore ACO
  • Mount Sinai Care, LLC
  • ProHEALTH Accountable Care Medical Group, PLLC
  • WESTMD Medical Group, P.C.



ACOs of New Jersey



  • Atlanticare Health Solutions
  • Barnabas Health ACO-North, LLC
  • Central New Jersey ACO, LLC
  • Hackensack Physician-Hospital Alliance ACO, LLC
  • HNMC Hospital/Physician ACO
  • Meridian Accountable Care Organization, LLC
  • Optimus Healthcare Partners, LLC
  • Summit Health-Virtua, Inc.
  • Walgreens Well Network can help with



  • Analytics
  • Billing
  • Bundle Payment
  • Care Coordination
  • Care Management
  • Consulting
  • Medicare IT
  • Platform Integration
  • Population Health Management (PHM)
  • Revenue Cycle Management (RCM)
  • Staffing
  • Technology Services



Why Techcusp?



  • American Firm
  • Attractive Pricing
  • Cutting-edge Technology Consultants
  • Deep Domain knowledge
  • Onshore/Offshore Delivery for scale & quality






Mihir Desai

Partner – Technology Solutions

Cell: +1 646.479.9539 / 201.258.4704 / 201.604.3480

Insurance IT | HealthCare IT | Banking IT | Staffing

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Safety Net Health Plans / Community Health Plans of America

Posted on December 8, 2014 | Categories: Health Exchange, Health Insurance, HealthCare, IT Services | Posted by: admin

Safety Net Health Plans / Community Health Plans of America





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Help with Care Management & Clinical Services – IT System & Software Development

Posted on April 20, 2014 | Categories: Care Management | Posted by: admin

Help with Care Management & Clinical Services – IT System & Software Development


Care Management & Clinical Services is our sweet spot. We could help you build state-of-the-art System from ground-up using our plug & play framework. It means, we could deliver you the smart system within your budget and time frame.


Techcusp has deep capabilities around:


  • Analytics
  • Billing & RCM
  • Care Coordination
  • Care Management
  • Case Management
  • Clinical Services
  • Informatics
  • Interactive Portal
  • Meaningful Use (MU)
  • MLTC
  • PACE
  • Population Health Management (PHM)
  • Tele-Health (mHealth)


Leading Software Vendor Companies (ISVs) in this space are:


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